REV-346 EX (8-92)

FOR REGISTER'S OFFICE USE ONLY

PA DEPARTMENT OF REVENUE

County Code

Year

File Number

ESTATE INFORMATION SHEET

DECEDENT INFORMATION:  Enter data as it will appear on all documents submitted to the department.

Name (Last)

(First)

(Middle)

Decedent's Social Security Number

Date of Death

Date of Birth

TYPE FILING:  Enter check (T) mark to indicate the nature of the return to be filed with the department.

Probate Return

Joint Assets Only

Estate Tax Only

Litigation Purposes (No Other Assets)

LETTERS GRANTED:

Enter check (T) mark to indicate the nature of the proceedings at the Register of Wills Office.
(Attach additional sheets if explanation is necessary.)

Testamentary              

Administration              

No Letters              

Other (Please Explain)

ATTORNEY/CORRESPONDENT: Enter all data concerning the attorney or other individual to receive all tax information and 

correspondence.

Name (Last)

(First)

(Middle)

Supreme Court I.D. No.

City

State

Zip Code

Telephone Number

PERSONAL REPRESENTATIVE Enter all data concerning the personal representative(s) of the estate authorized by the
           INFORMATION:

Register of Wills

Name (Last)

(First)

(Middle)

Social Security Number

Street Address

  Executor/Administrator

Street Address

Co-Executor/Administrator

Street Address

Co-Executor/Administrator

Street Address

Prepared By
     

rev. 10.13.06

City

 State                    Zip Code

Telephone Number

Name (Last)

(First)

(Middle)

Social Security Number

City

State

Zip Code

Telephone Number

Name (Last)

(First)

(Middle)

Social Security Number

City

State

Zip Code

Telephone Number

Date